15 different types of high school sports have a rate of at least 7 concussions per 100,000 athletic exposures. In most of those cases, wait and rest is the standard of care when post-concussion syndrome is evaluated to be present. The highest incidences of concussions occur in these sports: American football, hockey, rugby, soccer, and basketball.
In recent years, Boston University has been studying the brains of ex-NFL players who have died, most of un-natural deaths and mental health issues at young ages. Every single one of the players brains showed Chronic Traumatic Encephalopathy (CTE), bruising to the brain that causes permanent brain cell damage and death and subsequent symptoms, many times leading to mental health problems. This is what the movie Concussion with Will Smith was about. Many of the players struggled with addictions and drug use as a coping mechanism for the pain caused by their head injuries.
An important part of their study is that it includes a high school soccer player who died at the age of 24 years old from a drug overdose after sustaining 19 mild concussions. His brain showed evidence of CTE. This information is disconcerting because it shows us the risk that youth and student athletes are putting themselves in by playing contact sports. If you love your sport and don’t plan on stopping play, keep reading on tips to keep your brain well while playing your favorite sport.
Five Stages of Returning to School and Play Following a Concussion
Stage 1: First you should immediately see your primary care physician or a doctor you trust to have your cognitive and physical abilities evaluated immediately following a blow to the head. If concussion is suspected, a qEEG Brain Map should be performed by a trained brain functioning doctor to identify which areas of the brain are impacted and how severe the concussion truly is.
Staying home and resting, usually for approximately 2 – 4 days, following your doctor’s recommendations, can help the brain to heal immediately after injury. Nonessential screen time should be eliminated and only computer use for homework if necessary, in 15 minute blocks, should be done.
When should a student go back to school?
Re-entry into school is much more difficult to figure out. General rule of thumb suggests that when a student can tolerate 30 minutes of exposure to light, light reading, and listening he or she can return for at least a half day of school. School work should be modified to help the student engage with the content without hurting his or her brain worse. This might include test accommodations, more time to learn the information and using a peers notes to support learning. At school breaks should be taken as needed by lying down in quiet. Classes that worsen symptoms should be avoided such as band, difficult second languages, and Phys. Ed. Working with the school’ nurse, athletic trainer, and counselor is pivotal at this point.
Light stretching, if tolerated, can be done at this point to prevent deconditioning for the athlete.
Stage 2: Once back in school full time with minimal to no symptoms, then the student athlete can consider light to moderate physical activity under the supervision of the athletic trainer. Exercising for 20 – 30 minutes will help the athlete begin to overcome the sluggish physical and mental feeling that has been experienced. Be sure not to push your body or your brain at this point because you are eager to get back to play. Once a full academic load plus full physical activity can be performed with no symptoms, stage 3 can be considered.
Stage 3: In this stage the student should be attending school full time with moderate to heavy cognitive and academic load with no problems. There may still be make-up work that needs to be completed slowly so as not to cause more problems for the person. Usually running and jumping is permitted at this stage but avoidance of any contact activities should still be followed. Once a full school schedule, plus full physical activity of 25-35 minutes of strength and cardio training is able to be performed with no worsening of symptoms the athlete can move to Stage 4.
Stage 4: This is the stage that most people think a return-t-play protocol begins because it consists of sport specific non-contact drills and exercises. Basically, the athlete can rejoin his or her team but cannot participate in high risk activities. The student athlete should stay in this stage until the treating doctor gives clearance to return to play. A qEEG Brain Map and a neurocognitive test, such as ImPact testing should be performed to assess brain functioning and be sure that the person is healthy enough to be involved in the sport again.
Stage 5: This stage is like graduation for the injured athlete. He or she is allowed to play their beloved sport again with no restrictions. All safety measures should be followed to avoid a second concussion which has been proven to be even more harmful to the brain.
Although this type of return to play protocol can take more time than anyone would like, it is essential for making sure the athlete is truly healthy before he or she engages in contact behavior again and it decreases anxiety and frustration along the way by setting the athlete up for success at every stage of the way.
Concussions from Playing Football
Concussions from playing football have gotten the most attention in sports concussions and rightly so. Football accounts for 60% of sports-related concussions. Football is a high contact sport that involves high velocity hits and collisions.
Ryan Hoffman, a former UNC-Chapel Hill football player recently died, homeless after years of drug abuse and mental health issues. His sister fought for 15 years to prove that her brother’s change in personality and odd behaviors was a product of concussions that he sustained while playing football during college. She finally received validation of her beliefs, although too late, when Boston University confirmed her fears that Ryan showed evidence of CTE, just like all the other players in the study. The evidence is mounting an enormous showing that football leads to head injury for many players of all ages and at all levels.
Although helmets exist that can measure the impact a brain takes following contact or a hit, using qEEG Brain Mapping the player, coach and parents can actually the damage that has been done to brain functioning. “Seeing how the brain is affected by a hit in a football practice or game is much more powerful.” states Dr. Trish Leigh from Leigh Brain and Spine, who is passionate about helping athletes keep their brains healthy while playing the sports they love. “If we have a baseline of brain functioning, through an annual screening, then we know precisely how the brain has changed, or been injured, following a hit.”
The Center for Disease Control (CDC) recommends annual baseline brain functioning checks to make sure youth are keeping their brains healthy as they continue to play football. Baseline testing should include qEEG Brain Mapping, a neuropsychological test of thinking, memory, and reaction time skills, and a history of factors that might make concussion recovery more difficulty such as: ADHD, mood challenges, anxiety, depression, learning disabilities, and chronic headaches.
If you play football and want to keep your brain healthy follow these tips:
Brain Supplements: Take a brain enhancing supplement like DHA/EPA Omeg-3 oils that have been shown to help keep your brain cells healthy.
Shock Absorbing Helmet: Wear your helmet and make sure it is secure. You can even go one step further and buy a helmet that has shock absorbing exterior to help soften blows.
Mouth Guard Use: Wear a mouth guard, even if you don’t think you need one. The mouth guard will absorb shock from a hit a help your brain stay healthy. A new study showed that high school athletes that wore custom-fitted mouth guards had half as many concussions as those who wore generic guards.
Neck Stabilizer: Stabilize your neck to prevent whiplash like movement during a hit. The United States Army Research Lab has begun to create a neck stabilizer that attaches to a player’s waist by straps and the neck piece becomes more fluid filled as there is stress on it. This acts like a shock absorber for the neck during an impact.
Brain specialists have said in recent years that there is another sport that will rival football in its dangers for concussion: soccer. A recent class action law suit was settled limiting heading in youth soccer as a means to prevent the rising numbers of head injury. A new study in the Journal of American Medical Association showed that there has been an increase in concussions of the past decade in youth soccer and that girls playing soccer are more affected than boys.
To reduce the likelihood of concussions in soccer, athletes are recommended to not play goalie (this position takes the most hits) decrease the amount and intensity of collisions, and not head the ball. Wear a concussion headband. Didn’t know they exist. They do and they are practical and cool. Ali Krieger, of the US Team, is one of many professional soccer players who have begun to wear a concussion headband to prevent concussions in the first place. Krieger, who has suffered from a concussion in the past had even more motivation to wear the band. The headband costs less than $50 dollars and can add another layer of protection to the brain.
Pre-season conditioning of proper heading form can be essential for protecting the brain of a player who chooses to still head the ball. “Purposeful Heading”, as it is being called by some soccer minded physicians, rarely results in concussion. This means if players receive more training on how to properly head the ball and more importantly when to head the ball, less heading would lead to brain injury. For example, avoiding heading when near another player, a goal post, or wall when indoors can prevent many head injuries that occur. Being smart and using your head in the deciding process can be the best prevention to concussion.
If you have a blow to your head, do not keep playing. If it is a practice, be done for the day, possibly two. If it is a game, stay out for the rest of it. Rest and take time to allow your brain to come back on line. After working with many college athletes at top universities, Dr. Trish Leigh knows how hard it is for student athletes to make that decision during the time of injury. Many of the athletes admitted to Dr. Leigh that they could pass the sideline concussion tests, but knew they were not OK. They should have spoken up and told their coach or trainer but they did not want to let anyone down. After finally getting into treatment with Dr. Leigh, because of the long term problems that their concussions had cost them, could the athletes see the mistake in pushing through and going back on the field after sustaining a concussion.
A 2012 study in the journal Pediatrics showed that 375,000 youth are sent to emergency room each year for a concussion. Concussions spiked 70% on the court over the past 10 years. Concussions mainly result from players jumping up to get the ball before another player, colliding with that player, or falling to the ground and hitting their head very hard on the ground as they do. In youth basketball, more athletes are hit in the head by rogue balls that come flying through the air with speed and not accuracy. This type of hit can result in concussion as well, even though the athlete might not seem to have hit their head very hard.
The rate among girls is soaring. Teens are playing more aggressively than ever, especially girls. The cautionary tale of Niki Popyer should make anyone think twice before killing in on the court. Niki was a star basketball player in middle school and high school but continue to hit her head because she played so hard. “I wanted to win” she says. Now she cannot complete school work, suffers from constant headaches, mood swings plague her, and her chance of going to college has dwindled to a dream of her being a college player that has dissipated.
Why are girls affected more by concussions in basketball than boys?
53% of players admitted that they continued to play even though they had a headache after hitting their head. 54% of players said they always or sometimes might report a concussion to their coach. That leaves 46% of players not reporting an injury to their coach. It is suspected that more young men are playing through injuries and putting themselves in harm’s way. If a player sustains another head injury while already concussed, the results can be severely and permanently damaging.
How Can I Prevent a Concussion?
Prevention can be easy if it is not over thought. Here are some “simple” steps. Simple is in quotes because they are so obvious but people violate them all the time and end up with head injuries. Don’t over think it, just do it!
Seatbelts: When in the car always have the proper seatbelt or seat for children in place.
Helmets: Always where one when;
- riding a bike, motorcycle, ATV, scooter, skateboard, longboard, anything with wheels and momentum
- playing contact sports like football, boxing, baseball while batting and running bases, etc.
- horseback riding
- skiing and snowboarding, even sledding.
Don’t Take Stupid Risks: Avoid risky thrill seeking behavior that has a high risk for ending in a brain injury
Concussion Prevention for Young Children
- safety locks on windows to prevent falls
- soft ground cover on playgrounds and play areas to soften falls
Concussion Prevention for the Elderly
- keep paths clear and reduce clutter
- install handrails and hand bars throughout your home if necessary
Leigh Brain and Spine is proud to have earned the distinction as a Certified Brain Health Coach Center and is a proud member of the Amen Clinics referral network.